Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 359440 | UT |
NPI | 1154364891 |
---|---|
Provider Name | Robert D Christensen |
First Address | Spanish Fork, UT 84660-0010 |
Second Address | Provo, UT 84604-3380 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 15/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D2333 | (05) | UT |
G31024 | (02) | |
P00180292 | RAILROAD (01) | UT |